NCPRIMA’s Lodging Scholarship
NCPRIMA will award lodging scholarships to up to 10 individuals to attend the NC Public Risk
Management Association’s Annual Conference, Wrightsville Beach, September 11-14, 2011.
APPLICATION DEADLINE: June 30, 2011
Each scholarship recipient may receive up to 3 night’s standard room lodging (including tax) credit at the host hotel. This scholarship does
not cover any other charges (i.e. registration fees, food, movies, phone calls, travel related expenses/parking, etc.) associated with the
conference. Scholarship benefits are not transferrable.
To be eligible one must be responsible for Risk Management related functions at a government related organization (Municipality,
County/City/Town Government, State/Local Agency, School System, or Authority).
You do not have to be a NCPRIMA member to qualify.
Applicants must complete the attached Application Form; the form can also be obtained from Lynn Smyth at firstname.lastname@example.org.
The application must include supporting documentation, such as financial statements or budget summaries.
Completed applications should be sent to: Lynn Smyth, Assistant City Manager, City of Statesville, P. O. Box 1111, Statesville, NC
Deadline: Applications must be postmarked no later than June 30, 2011.
This scholarship opportunity will only cover the standard lodging expenses (September 11, 12, 13) associated with NCPRIMA’s 2011
Annual Conference. Recipients will be responsible for all other expenses not covered by the award. Recipients are expected to attend a full
complement of educational sessions and other events held during NCPRIMA’s Conference. They’ll also be asked to complete a brief
evaluation of the scholarship program at the end of the conference. Recipients will be required to pay the registration fee and annual
membership dues no later than July 30, 2011, or forfeit the scholarship.
NCPRIMA’s Lodging Scholarship Program for 2011
Use this application form to apply for a Lodging Scholarship to attend NCPRIMA’s 2011 Annual
Conference at Wrightsville Beach, NC September 11-14, 2011.
Please answer all questions. Continue on additional sheets, if necessary.
Name: ______________________________________________ Title: __________________________________________________
City: _______________________________________________________________ State: ______________ Zip: ________________
Phone: (work)___________________________ (cell) ___________________________Fax:___________________________________
Provide a brief profile of your organization, including a description of services and/or constituencies served:
Describe how the risk management and insurance functions are handled in your organization:
Please describe any of your previous involvement with NCPRIMA in the past as a member or non-member:
State your expectations, purpose, and goals in attending the conference:
Provide a brief statement of financial need. Please include your travel budget details for the past 3 Fiscal Years.
I affirm that the information provided on and with this application is true, to the best of my knowledge. I further affirm that I
am not receiving full reimbursement for lodging from my employer or any other outside source. I understand that an
incomplete application will not be considered for this award period.
I understand that the information in my application will be shared with the Scholarship Evaluation Committee and the NC
PRIMA Board of Directors for the purpose of evaluating my application. My scholarship application information will not be
shared with or given to any third party.
If selected, I agree to attend the Educational Sessions during the NCPRIMA Annual Conference September 11-14 2011.
Signature: _________________________________________________________ Date: _________________
Send completed applications postmarked by June 30, 2011 to:
Asst. City Manager
City of Statesville
P.O. Box 1111
Statesville, NC 28687